Cannabis and Anxiety
by Patricia Frye, MDMany physicians are now being asked if cannabis is an effective treatment for anxiety. Actually, it is one of the more common reasons patients seek a recommendation for medicinal cannabis.
Anxiety is a relatively common disorder characterized by worry and anxiety that is excessive and difficult to control. It can negatively impact relationships, job performance and quality of life. Excessive worry can make it difficult to fall asleep and often interrupts sleep, with patients being unable to sleep more than two to three hours before waking up. Anxiety can cause somatic symptoms such as shortness of breath, hyperventilation, sexual dysfunction, abdominal cramps and even chest pain.
Some patients suffer from social or performance anxiety that interferes with their ability to carry out certain tasks required by their job or position, such as speaking in front of a large group. This type of situation can cause hyperventilation, sweating, flight of ideas, rapid heart rate and feeling faint. Others experience ongoing anxiety that is driven by the pressure to meet deadlines, quotas or sales goals. This type of anxiety often leads to headaches, forgetfulness, neck pain from muscle spasm, poor appetite, chronic nausea, poor concentration and disturbed sleep.
There is almost always some degree of anxiety that evolves during or after a prolonged or serious illness. For patients with chronic pain, it is very important that this is addressed because anxiety can contribute to persistent pain. It has been shown that anxiety causes neurotransmitters in the brain to signal mediators that cause inflammation, which, in turn, causes pain. It is very difficult to alleviate pain in patients with chronic back pain, neuropathy, fibromyalgia and other pain syndromes without treating underlying anxiety.
Pharmaceuticals, like benzodiazepines, are used to treat anxiety and anxiety-induced insomnia but can be sedating and are highly addictive and prone to abuse. While antidepressants can be safely used to treat anxiety without the risk of addiction, some patients experience undesirable side effects such as drowsiness, weight gain or loss of libido. Exercise is a very important tool in fighting anxiety. It has been shown that 30 minutes of vigorous aerobic exercise is very effective in reducing anxiety and is something that every patient should at least attempt to incorporate into their anxiety-relieving regimen.
The anti-anxiety effects of certain strains of cannabis do not stem from THC. While low doses of THC can squelch anxiety, strains higher in THC, the only psychoactive compound in the plant, are more likely to produce anxiety and paranoia in users.
Rather, a secondary compound, cannabidiol (CBD), is primarily responsible for treating the cause of these kinds of symptoms. CBD, unlike THC, has little binding affinity for either the CB1 or CB2 cannabinoid receptors found in the human brain, so it doesn’t cause the “euphoric high” associated with THC. Instead, it interacts directly with several other receptors to produce a variety of therapeutic effects.
One of those receptors is the 5-HT1A serotonin receptor which helps mediate a variety of biological and neurological processes, one of which is anxiety. When CBD binds to it, the result is that it slows down 5-HTIA signaling, which in turn minimizes the body’s excitatory responses, thereby reducing anxiety. Certain terpenes, which are substances found in cannabis and throughout the plant world, like limonene (citrus) and linalool (lavender) also add to the anti-anxiety effect of cannabis.
Decreased appetite and increased energy are side effects that are commonly associated with CBD although for some patients, these may be added benefits. CBD also has the potential to interfere with the metabolism of certain medications, so it’s important to review this with your healthcare provider before starting CBD.
Since CBD does not cause psychoactivity, it's an appropriate treatment for those who need to remain clear-minded. So, if anxiety is impacting your life in a chronic and negative way and conventional therapy has been ineffective or causes undesirable side effects, consider the benefits of medical cannabis. It’s a natural way to feeling better.
Patricia C Frye, M.D. is the founder of Takoma Alternative Care, located at 6930 Carroll Ave., Ste. 412, Takoma Park, MD. For more information, call 301-328-3045 or visit TakomaCare.com.